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Double Barrel Vein Anastomosis In Microvascular Free Flaps
Brenton R. Robinson
Robert L. Walton
University of Pittsburgh
2021-01-27
Presenter: Brenton Robinson
Affidavit:
Vu Nguyen
Director Name: Vu Nguyen
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Free tissue transfer has revolutionized the reconstruction of complex 3-dimensional defects. In most cases flap failure can be attributed to venous thrombosis. We present a simple and effective technique that takes two smaller vessels and creates one common lumen for vein-to-vein anastomosis in free tissue transfer minimizing operative time and improving venous drainage.
Methods: In microvascular free flap soft tissue reconstruction we performed venous anastomosis utilizing a side-to-side anastomosis of the two converging venae comitantes to create one common lumen. The newly formed "common lumen" was anastomosed in a standard end-to-end fashion to the recipient outflow vein. Primary end point consisted of clinical signs of venous congestion or flap failure.
Results: Overall 12 microsurgical flaps were included. All the cases were reconstructive, and the majority of cases were performed in patients undergoing free tissue transfer for post-mastectomy breast reconstruction. In all patients undergoing double barrel vein anastomosis there were no flap failures or clinical signs of venous congestion.
Conclusion: Free tissue transfer with a double barrel configuration of the venous anastomosis was associated with a negligible rate of venous thrombosis, found to be technically feasible, easily reproducible and was associated with a reduction in flap ischemia time and overall operative time.
